How the Heritage Foundation, a Conservative Think Tank, Promoted the Individual Mandate

James Taranto, who writes the Wall Street Journal’s excellent “Best of the Web” column, put forth a lengthy and informative discussion yesterday on the conservative origins of the individual mandate, whose inclusion in Obamacare is today its most controversial feature on the Right.

This came up at Tuesday’s Western Republican Leadership Conference Debate, where Mitt Romney and Newt Gingrich tussled on the question:

ROMNEY: Actually, Newt, we got the idea of an individual mandate from you.

GINGRICH: That’s not true. You got it from the Heritage Foundation.

ROMNEY: Yes, we got it from you, and you got it from the Heritage Foundation and from you.

GINGRICH: Wait a second. What you just said is not true. You did not get that from me. You got it from the Heritage Foundation.

ROMNEY: And you never supported them?

GINGRICH: I agree with them, but I’m just saying, what you said to this audience just now plain wasn’t true.

(CROSSTALK)

ROMNEY: OK. Let me ask, have you supported in the past an individual mandate?

GINGRICH: I absolutely did with the Heritage Foundation against Hillarycare.

ROMNEY: You did support an individual mandate?

ROMNEY: Oh, OK. That’s what I’m saying. We got the idea from you and the Heritage Foundation.

GINGRICH: OK. A little broader.

ROMNEY: OK.

(Romney was prepared to go on, but Michele Bachmann, in her usual role as the person who makes the debates less useful, interjected and changed the subject. Here’s a YouTube video of the entire debate. The Gingrich-Romney exchange begins at the 27:38 mark.)

Taranto, who employs the royal “we” in his column, writes that he was there when the Heritage Foundation was promoting the mandate:

Heritage did put forward the idea of an individual mandate, though it predated HillaryCare by several years. We know this because we were there: In 1988-90, we were employed at Heritage as a public relations associate (a junior writer and editor), and we wrote at least one press release for a publication touting Heritage’s plan for comprehensive legislation to provide universal “quality, affordable health care.”

As a junior publicist, we weren’t being paid for our personal opinions. But we are now, so you will be the first to know that when we worked at Heritage, we hated the Heritage plan, especially the individual mandate. “Universal health care” was neither already established nor inevitable, and we thought the foundation had made a serious philosophical and strategic error in accepting rather than disputing the left-liberal notion that the provision of “quality, affordable health care” to everyone was a proper role of government. As to the mandate, we remember reading about it and thinking: “I thought we were supposed to be for freedom.”

The plan was introduced in a 1989 book, “A National Health System for America” by Stuart Butler and Edmund Haislmaier. We seem to have mislaid our copy, and we couldn’t find it online, but we did track down a 1990 Backgrounder and a 1991 lecture by Butler that outline the plan. One of its two major planks, the equalization of tax treatment for individually purchased and employer-provided health insurance, seemed sensible and unobjectionable, at least in principle.

But the other was the mandate, described as a “Health Care Social Contract” and fleshed out in the lecture.

We would include a mandate in our proposal–not a mandate on employers, but a mandate on heads of households–to obtain at least a basic package of health insurance for themselves and their families. That would have to include, by federal law, a catastrophic provision in the form of a stop loss for a family’s total health outlays. It would have to include all members of the family, and it might also include certain very specific services, such as preventive care, well baby visits, and other items.

Taranto points out that the Heritage mandate was less onerous than the Obamacare one, as it focused on coverage for catastrophic illness, rather than the comprehensive health plans that Obamacare requires. “On the other hand, Butler’s vague language—‘it might also include certain very specific services…and other items’—would seem to leave the door wide open for limitless expansion,” he writes. “Whatever the particular differences, the Heritage mandate was indistinguishable in principle from the ObamaCare one. In both cases, the federal government would force individuals to purchase a product from a private company—something that Congress has never done before.”

In the multi-state Obamacare constitutional challenge before the 11th Circuit Court of Appeals, in which the individual mandate was overturned, Taranto points out that the Obama Administration cited the Heritage Foundation in its defense of the individual mandate. Heritage, in response, filed an amicus brief accounting for its “prior support for a qualified mandate” and asserting that Heritage has been “consistent” in its view of the constitutionality of a mandate:

If citations to policy papers were subject to the same rules as legal citations, then the Heritage position quoted by the Department of Justice would have a red flag indicating it had been reversed. . . . Heritage has stopped supporting any insurance mandate.

Heritage policy experts never supported an unqualified mandate like that in the PPACA [ObamaCare]. Their prior support for a qualified mandate was limited to catastrophic coverage (true insurance that is precisely what the PPACA forbids), coupled with tax relief for all families and other reforms that are conspicuously absent from the PPACA. Since then, a growing body of research has provided a strong basis to conclude that any government insurance mandate is not only unnecessary, but is a bad policy option. Moreover, Heritage’s legal scholars have been consistent in explaining that the type of mandate in the PPACA is unconstitutional.

Taranto isn’t completely buying it: “From the Butler quote above, it seems to us that the brief overstates the extent to which the proposed Heritage mandate was ‘limited,’” he writes. “But it is clear that Heritage has repudiated the idea of an individual mandate… All these years later, it pleases us that our erstwhile employer has come around.”

But Taranto speaks for many on the Right when he describes his mixed feelings about Mitt Romney’s embrace of the individual mandate:

But it worries us that Mitt Romney, who may well be the next president, lacked the instinct to be offended by the idea when it crossed his desk in Boston. To be sure, the legal distinction he makes between state and federal individual mandates is a sound and principled one. We would be hard-pressed to devise a theory under which the U.S. Constitution precludes state-level insurance mandates. And because of ObamaCare’s enduring unpopularity, we don’t even fear that Romney will flip-flop on this after taking office.

But the next time a think tank or a blue-ribbon commission comes up with an idea this bad, can we trust President Romney to reject it?

I think we can trust that many more people will make their opinions known in a national health-care debate than in a local one.

UPDATE: Peter Suderman picks up on something subtle and important in the Gingrich-Romney exchange: that Gingrich adopted the mandate as a tactic “against Hillarycare.” As Peter puts it,

This tells you something about why Republican party leaders have had such a hard time addressing health policy issues over the last few years. Rather than make a prolonged case for health policy that does not involve endless expansion of entitlements and insurance subsidies, the GOP has instead focused primarily on reacting to Democratic proposals. The individual mandate was an attempt to beat Democrats at the universal coverage game and preempt the what would become HillaryCare. Medicare’s prescription drug benefit was passed by a Republican president and a Republican Congress under the pretense that if they didn’t do it, Democrats would, and it would be worse. In the debate over ObamaCare, Republicans spent more energy arguing against the law’s Medicare payment cuts than any other part of the law. Riding a wave of anger over ObamaCare’s passage to electoral victory in 2010, party leadership continued to refuse to talk about broader entitlement reform. And now they’re on track to nominate a presidential candidate who, in his only gig as an elected official, signed a state-based law that would provide the model and foundation for ObamaCare—their top legislative target.

I have similar concerns about what may be the premature conservative enthusiasm for high-risk pools as the solution to the pre-existing conditions problem. (I fear that high-risk pools are public-employee pensions v2.0, and that a better solution is to move away from the employer-sponsored insurance system.)

UPDATE: John Goodman says: “Did the ideas behind ObamaCare originate at the Heritage Foundation? I would say ‘no.’ They originated with [Stanford economist] Alain Enthoven. But Heritage played a role.” I’ll have more on the history of the individual mandate in a future post.

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Avik, I don’t think that Mrs. Bachmann could have made the conversation less informative than it was when Mr. Romney and Mr. Gingrich were discussing where to find the trace elements of the individual mandate!

You lost your right to choose a long time ago. Anytime someone walks into a hospital needing heart surgery without insurance, is treated, and walks away from the bill…guess who pays? We do, and we have no choice.

We pay because the hospitals are required by law to treat anyone who walks in. The laws in this area originally applied to emergency services at public hospitals, but the real prospect of getting sued soon turned this into a free benefit, and now it;’s a de facto form of coverage.

I’m pretty sure it wasn’t the GOP who created this situation, except by letting it happen to avoid criticism. Now we’ve got a mess that threatens to bring down the whole system or turn it into a permanent government handout.

To put your post another way, you seem to be saying that we should refuse people medical care and let them die because at least they were able to choose to not have health insurance. Since many people don’t have health insurance because they would be choosing between eating dinner or paying for something that will happen in the future, it seems disingenuous to use the word “choice” at all. Juast as it is lame to claim that needing health care is a choice just as owning a car is a choice. Everyone needs medical care, there is no way aroud it. If you do not have health insurance you are a freeloader.